How Should I Treat Meals?

I've had diabetes for 21 years (and used insulin for 16). What should my blood sugar level be one to two hours after eating? Should I inject insulin to lower my level? If the blood sugar of a person without diabetes should be about 120 mg/dl after a meal, isn't it logical that I should strive to keep mine the same?
Morrie "Mo" Ostergard, Davis, Illinois

Mary M. Austin, RD, MA, CDE, FAADE, responds: I commend you on your interest in keeping your blood glucose in as "normal" a range as is possible. In people who do not have diabetes, blood glucoses do not rise above 140 mg/dl two hours after eating a meal.

What to Know: For people with diabetes, the American Diabetes Association recommends that fasting blood glucoses should be maintained in the range of 70 to 130 mg/dl. One to two hours after the beginning of a meal, blood glucose "peaks" should be below 180. The ADA recommends, however, that these guidelines be individualized to the needs of the person with diabetes. The rise and fall of blood glucose after a meal are determined by many factors, including what you ate, how much background insulin you had "on board," your physical activity level, and other factors beyond your control.

Find Out More: The post-meal blood glucose target of 120 mg/dl that you suggest may put you at needless risk for hypoglycemia because rapid-acting insulin you take at mealtime continues to be active for about four hours. Injecting additional insulin two hours after a meal to "improve" your blood glucose could be a hasty response that leads to a dangerous hypoglycemic event. In addition to measuring your glucose level one to two hours after the first bite of a meal, it may be useful to record the result of your next regularly scheduled check—is the level in the comfortable 70-to-130 mg/dl range by then?Takeaway: I would recommend discussing with your health care provider your blood glucose monitoring results, your current A1C level, and what your personal fasting and post-meal blood glucose targets should be to keep you healthy and in a safe range to avoid hypoglycemia.